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Factors Impacting on Biopsy Examination Turnaround Time

Introduction

Timeliness of effect is considered an important aspect of the services provided by lab. To provide the clients accurate, well-timed and relevant information is one of the fundamental targets of quality guarantee programs in anatomic pathology. Turnaround time (TAT) is thought as enough time when test is ordered until the end result is reported. In 2000 Rosai also explained that the purpose of anatomic pathology turnaround time is to monitor the timely reporting of operative and autopsy pathology specimens and right any deficiencies encountered.

In the medical diagnosis of cancers and other disease condition, time is very essential. Timely reporting of results will decrease the length of clinic stay for the in-patients. It will also provide relevant information for the referring medical professionals that will assist them offer an appropriate treatment to the patients. Furthermore, timeliness of final result can reduce the period of doubt for the patients' looking forward to their effect.

In our organization, postponed turn-around time is one of the major problem. Hence, this study is conducted. The study aims to identify the factors that impact the medical pathology turnaround time in our institution. Based on the prior studies, TAT is long term due to the following factors: larger institutional size, better specimen volume, postponed slide delivery, reduced support personnel, and the integration of pathology trainees. In 2011 Patel et al show that examination of malignancy, consultation with other pathologists, having got frozen section, quantity of H and E slides and use of immunohistochemical discolorations were significantly associated with an increase of turnaround time.

Identifying factors that extended the turnaround time is step one in employing process improvement in the work circulation system of our institution. This study can help us identify the areas of weakness in the lab that can help us improve our service.

Review of Related Literature

Turnaround time is split into three phases: Preanalytic, analytic and postanalytic stage. The pre-analytical stage include specimen collection, transfer and handling. The analytical stage include the screening and the post analytical phase include transmission, interpretation and follow-up. The three functions are called the screening process. In medical pathology, analytic stage can be divided into technical part and evaluation. The technological part include gross evaluation, tissue handling, microtomy, staining, and mounting while research part include reading of biopsy specimens. In 2014, a report by Shamim et al confirmed that almost all of the delays are in the analytical phase. This can be scheduled to machine breakdown. In 2003, Bilwani et al pointed some of the reason why of postponed turnaround time and these include machine break down, delay in maintenance analyzer and scheduled to computer shut down. Among the factors which may have significant contribution to delayed turnaround time are medical diagnosis of malignancy, consultation with other pathologists, range of H and E slides and the utilization of immunohistochemical spots. Cases having an increased number of H and E slides demonstrates submission of additional cells specimens and requires complex time and energy to complete the specimens (Patel, 2000). According to Bowers in 2012, specimens that require special handling has a specific significant impact in turnaround time. There is an increased in turnaround time in specimens that require special handling when compared with specimens of routine instances. Some specimen types that want over night fixation can prolong the control time. Within this study, the author also quoted that governmental establishments were found to obtain significantly longer turnaround time than non-governmental establishments. In 2013, Volmar et al. , mentioned that the longer turnaround time in governmental organization is a representation of different staffing patterns and/or turnaround time anticipations in certain organizations.

Specimen type also ranges in their turnaround time. Radical cancer resections have longest median turnaround time. That is followed by non-radical malignancy resections and non-cancer resections have a least number of days in turnaround time (Bowers, 2012). Specimen types that are associated with longer turnaround time include gastrointestinal, breasts, lung and genitourinary. This is described by an right away fixation of these specimens. (Volmar et al, 2013). In 2013, Forlenza et al, the turnaround time for pediatric oncology pathology differs according to identification. Tumors of the CNS gets the most increased in TAT, this is accompanied by sarcoma, ovarian tumors, kidney tumors, thyroid tumors, schwannoma/neurofibroma, nasopharyngeal carcinoma, kidney tumors, testicular tumors, lymphoma, neuroblastoma and hepatoblastoma.

Interdepartmental consultation on complex conditions can also extend the turnaround time. Ribe et al. , described that complex conditions can improve the turnaround time because of additional time for complete control and special studies such as immunohistochemical staining. Large specimens require more time of fixation and calcified tissue require decalcification which is time consuming. Other factors that affects the turnaround time are the need of additional recuts and review and reprocessing of past operative pathology or cytopathology. (Ribe, 1998). Significantly longer turnaround time was also associated with pulling old slides for review and getting in touch with the health professionals for additional information. (Jones, 2001)

Manpower is an essential element in any institutions that require quality service. Staffing practices can even be one factor in the timeliness in operative pathology result. A report by Volmar in 2013, almost all of the organizations (51. 9%) reported staffing of 12 hours or less. A small percentage (13%) of corporations having 24 hour staffing.

For corporations with training program, in 1996, Zarbo et al pointed the factors that contributed to increased turnaround time and included in these are the following: Regular responsibility for gross dissection allocated to residents only and residents' engagement in putting your signature on out of end result. In 1999, Jones et al cited that turnaround time was significantly longer when residents or fellows were involved in screening and releasing of results. The need to contact the joining physician for more information can also provide a longer turnaround time.

According to the Connection of Directors of Anatomic and Surgical Pathology (ADASP) turnaround times are changing depending on case complexity and other factors such as the presence of a residency training program. The criteria may change over time with the development of new solutions and other factors. They also stated that suitable turnaround time "should be determined based on current literature, remember that appropriate turnaround times are also identified by the accrediting bodies. (ADASP, 2012)

In Davao City, the average turnaround time of tertiary private hospitals is seven days. In our establishment the turnaround time for biopsy specimen is 10 days.

Our institution is a administration training clinic and one the recommendation centers in Mindanao. Annually, there can be an increasing level of specimens that we received. In 2013 the biopsy census was roughly 7000 and 8000 in the entire year 2014. This study aims to recognize the factors that impact the delayed turnaround time in our establishment.

Research Question

What will be the factors that have an effect on the medical pathology turnaround time in Southern Philippines INFIRMARY?

Significance of the Study

Turnaround time is an essential component of quality actions in operative pathology. To put into practice new system for bettering the turnaround time in operative pathology, one must have the ability to identify first the factors that affect the turnaround time. Figuring out these factors will be of assist in fixing our problem. Hence, this review will enable us to identify regions of weakness that will lead us to implement changes which will enhance the service of the lab in our institution. Such changes include formulation and planning of protocols that can help upgraded the turnaround amount of time in surgical pathology. The info that will be collected at the end of this review will serve as a guide data. This data can be used for future studies that may compare the turnaround time after the implemention of changes. Furthermore, this study serves as an analysis of the efficiency in our laboratory in conditions of biopsy specimens.

General objective

The general aim of this research is to look for the factors that have an effect on the analysis period of turnaround time of biopsy specimens in Southern Philippines INFIRMARY.

Specific Targets:

  1. To determine the mean turnaround time of biopsy specimens in Southern Philippines Medical Center.
  2. To see whether the following factors are significantly associated with delayed turnaround time:
  • Non-Radical or Radical Specimens
  • Number of specimens and H and E slides
  • Cancer versus Non-cancer Cases
  • Consutation with other Pathologists
  • Tissue decalcification
  • Frozen section biopsy
  1. To determine which of the aforementioned factors can cause more delays compared to the rest.
  2. To determine which organ system specimen type is significantly associated with delayed turnaround time.
  3. To determine whether average TAT is significantly different between:
  1. cancer and non-cancer cases

b) radical and non-radical specimens

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